Promotion of Reproductive Healthcare and Services by Community Health Promoters in Narok West sub-county, in Narok County, Kenya

Abstract

Reproductive health (RH) is a critical component of community well-being both globally and in Kenya. However, the limited number of RH professionals and the unequal access to RH services, particularly in the low- and middle-income countries (LMICs), remain persistent challenges. In Kenya, rural and remote areas, especially the previously marginalized communities such as Narok West sub-county are disproportionately affected. This study aimed to investigate the level of RH care promotion by community health promoters (CHPs) in Narok West sub-county, in Narok county, Kenya. Employing a cross-sectional survey design and mixed-methods approaches, the study collected and analyzed both quantitative and qualitative data from randomly selected CHPs serving in the sub-county and purposefully sampled community members who were residents of the subcounty during the study period. Secondary data on the key indicators of level of RH promotion by the CHPs for this study, were also obtained from the Kenya Health Information Management System (KHIMS). Quantitative data were processed and analyzed using descriptive statistics (frequencies, means, medians, percentages) and inferential methods for relationships between the variables, such as multivariate regression (with statistical significance level set at P < 0.05). The results of quantitative data analysis were summarized and presented using tables. The qualitative data was analyzed thematically, interpreted using direct quotes of the respondents to represent participant voices. This study reveals that there was sufficient level of RH promotion by the CHPs in the sub-county during the specified study period (2024) as indicated by the total of 7,599 RH promotional activities, 4,288 of which were household visits, 2,237 maternal healthcare support and 1,074 childbirth and pregnancy-related referrals to health centers by the CHPs. More importantly, the study shows that the current CHPs have made substantial differences in the promotion of the RH services in the sub-county, by increasing the overall RH-related promotional activities by 53.3%, compared to previous promotion. Worth noting is the remarkable increase of 244% in the referrals and 34.6% in household visits, compared to the level of promotion in the year 2023. Some of the factors identified by this study as influencing the level of promotion by the CHPs include: formal training in RH services, methods used, community’s RH awareness, previous experience, and traditional and cultural beliefs on health. The formal RH-specific training was identified as an independent predictor of the number of maternal healthcare supports provided by the CHPs in this study. However, compared with the year 2023, the type of RH services promoted in the sub-county remained the same, meaning the training of CHPs was not adjusted to align it with the emerging and re-emerging RH-issues of RH-related cancers, teenage pregnancies and abortions, adolescents born with and living with HIV/AIDS, which was identified as key gap that need to be addressed. In summary the study reveals that the engagement of the current CHPs in promotion of RH services was not only working, but also may be feasible strategy to improve accessibility and availability of the RH services, especially in rural, remote and underserved areas such as the Narok West sub-county. But the scope should be expanded to address the identified key gap. These findings are significant for stakeholders, offering valuable insights into the role of the newly commissioned CHPs in advancing RH at level one of the healthcare system and contributing to Kenya’s broader goal of achieving Universal Health Coverage (UHC) through community-based healthcare.